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Deep Dive: The Opioid Tsunami

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Opioids are responsible for the worst drug epidemic ever to hit the United States. Shockingly, it is also the first one to have been “generated in the health care system,” says Nora Volkow. As physicians struggled to help patients suffering chronic pain, the pharmaceutical industry heavily promoted opioids and downplayed their abuse potential. Overdose deaths have risen steadily, quadrupling in the U.S. since 1999 as prescriptions soared.

The bright spot here is that addiction is increasingly recognized as a medical, not a criminal problem — a disease of the brain, not a disease of choice — and there are treatments that work.

By the numbers

Vivek Murthy offers sobering statistics about the extent of opioid addiction: More than 2.5 million people are addicted to opioids and another 12 million are misusing the drugs, and putting themselves at risk of addiction. Ninety people in the U.S. die every day from opioid overdose.

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Why are opioids so addictive?

Yasmin Hurd explains the neurobiology of addiction. Addiction can result from the ability of opioids to pass the blood-brain barrier, bind rapidly to receptors in the brain, and trigger a signaling cascade in the cells.

Who knew?

In as little as three days, exposure to opioids can start some people on a trajectory towards addiction. Genetics is a factor in individual vulnerability, as is the environment and the type of opioid in use; other mechanisms are also at play, but we don’t fully understand many of them yet.

In a journey across the U.S., Murthy realized that an epidemic of chronic stress is causing deep emotional pain. Yet doctors who fail to find a physical cause for someone’s health complaint too often dismiss the symptoms as “just in your head.”

Murthy says that misses a central truth. “You can experience emotional pain as physical pain. What is in your head is very real and it can influence your perception of pain.”

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We know how to treat opioid addiction— but we’re not doing enough of it

Nora Volkow describes three classes of drugs that provide effective treatment for opioid addiction. “When you treat opioid use disorder with any one of these medications you not only decrease the consumption of heroin or the opioid, you actually prevent overdoses, you prevent criminal behavior, you prevent them from recycling back into the prison system, and you improve the outcomes on your neonatal abstinence syndrome.”

Yet these treatments are underused, says Volkow. One reason is the stigma associated with their use, with some people arguing they just substitute one medication for another.

Another is the lack of infrastructure — there simply aren’t enough treatment programs to care for all of those who are addicted to opioids. Insurance gaps are also an obstacle.

Can marijuana help treat opioid addiction?

Leading in to a discussion about the promise of marijuana to combat opioid use, Hurd reminds us that “an epidemic calls for a different way of thinking.” Pilot studies suggest that the cannabinoids in the plant appear to decrease heroin-seeking behavior and possibly alcohol abuse. Unlike the THC in marijuana, cannabinoids do not have a rewarding effect.

Murthy underscores the importance of science to drive decision making about the use of marijuana, but observes that the federal government still restricts research.

Regulating marijuana to treat opioid addiction

A bill being considered by lawmakers in Maryland would make it the fourth state to explicitly legalize the use of marijuana to treat opioid-abuse disorder, following Pennsylvania, New York and New Jersey.